April 2020, an early peak of the SARS-COV-2 (covid-19) pandemic in the United States, was a difficult month. I knew I would cry in the bathroom or on a cab ride home. I recognized that I would watch someone painfully gasp for their last breath. Yet, as challenging as those early months of the pandemic were, I did not anticipate what was to come for many. Unfortunately, even after the resolution of the initial infection, a percentage of COVID survivors are plagued by constellation of persistent that continue to plague patients months after infection. This syndrome is called long COVID, and although it is not completely understood, it has negatively impacted many survivors physically and psychologically.

What is Long COVID?

Long COVID, seen in approximately 30 to 40 percent of patients, consists of one or more of the following symptoms: persistent brain fog, dull lingering headaches, fatigue, malaise, trouble falling and staying asleep, early morning awakening, and appetite changes with persistent GI distress.

Brain fog can be especially troubling for patients dealing with long COVID, making it difficult to focus and perform everyday tasks at work and home. Left untreated, brain fog can significantly impact quality of life.

Identifying Brain Fog

Patients struggling with brain fog often report feeling cloudy, and struggle to concentrate and attend to conversations and social cues, be they auditory or visual, virtual or in person. Slowed processing of events and communication is seen in these patients. Individuals report having a difficult time shifting focus between topics and relating to abstract, theoretical discussions. Brain fog is best described as the feeling of being stuck in an unrelenting cloud.

Preventing Long COVID

Using multiple layers of precaution in your daily life is the best way to prevent COVID infections and the possibility of developing lingering symptoms. These protective measures include proper mask-wearing, hand washing, and vaccination.

Maintaining a structured daily regimen (as described below), as well as increasing visual and auditory processing cues by getting outside and seeing new things, can help decrease the frequency and intensity of agoraphobia, and work to build resilience against brain fog before it starts.

Treating Long COVID

I have noted a decrease in frequency and intensity of brain fog, headaches, fatigue, insomnia, and GI distress with low doses of selective serotonin reuptake inhibitors (SSRIs) and selective serotonin norepinephrine reupdate inhibitors (SNRIs).

Within 6 to 12 weeks, low dose treatment has led to a lift in the so-called “dreary clouds” of Long COVID brain fog. Patients can quickly see light at the end of the COVID tunnel, and thus feel collectively less sad and worried. They stop dreading waking up the next day to a headache or inability to concentrate. Patients have a renewed ability to work, play with their children, establish routines, and find meaning in life.

Psychotherapy and Peer Support

Cognitive Behavioral therapy can shift negative ruminations and catastrophic thoughts to more neutral thoughts. I teach patients that it is not necessary to force positive thinking at this chaotic time, and coach them instead on shifting to neutral thoughts.

Virtual peer support through Survivor Corp can also play an important role in long COVID recovery.

Creating Healing Routines

Daily self-care routines are essential to health and overall well-being, especially for those struggling with ongoing neurological COVID symptoms. These routines can be as simple as getting into bed at 10 pm each night and reading for 10 minutes in bed.

Patients should have a morning routine that includes 15 minutes of movement, such as a walk outside. This will help maintain circulation and stimulate the brain with outdoor visual and auditory cues. Hydration is also a critical part of a healthy daily routine. I recommend drinking half of your weight in ounces.

In addition to morning and evening routines, patients must work towards eating at similar times, creating an environment conducive to improvements in appetite and limit mindless snacking. For example, someone with long COVID might feel more comfortable skipping breakfast due to initial COVID-19 belly aches in the mornings, but should work toward eating three meals a day at consistent times.

Maintenance of a healthy sleep routine should include getting into bed at 10 or 10:30 pm with the goal of falling asleep by 11 pm. Consider an audiobook or podcast instead of visual reading at the end of the day. This will help alleviate visual processing fatigue associated with constant Zoom meetings.

Taking healthy breaks from social media and news media is also an important piece of the recovery process. It is vital to maintain healthy boundaries with the type of online information you are consuming. This will eliminate processing fatigue and reactivation of the media trauma cycle.

It is also crucial to have things to look forward to after school, work, or on the weekends, rebuilding joy and pleasurable activities into their routines.

You Don’t Have to Live with Brain Fog

With new cases of COVID on the rise and the spread of the delta variant, long COVID will likely impact millions of Americans.

If you are struggling with brain fog due to long COVID, please reach out. Working with me to help tailor your daily regimen can alleviate lingering symptoms, giving you renewed ability to focus, sleep, and enjoy life.

Let’s work together to lift you out of the COVID fog.

About the Author

Dr. Jordana M. Cotton
Dually Board-Certified Psychiatric NP and CNS

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